# Incidental duodenal leiomyoma discovered during robotic SADI: A case report of surgical adaptation and successful outcome

## TL;DR

A rare duodenal tumor was discovered during bariatric surgery, and the procedure was successfully adapted to achieve good patient outcomes.

## Contribution

This case report demonstrates successful intraoperative adaptation during robotic bariatric surgery upon discovering an unexpected duodenal leiomyoma.

## Key findings

- A duodenal leiomyoma was incidentally discovered during robotic SADI surgery.
- Conversion to robotic mini gastric bypass (MGB) resulted in 90% excess weight loss and diabetes remission after one year.
- Histopathology confirmed the tumor was benign, emphasizing the importance of intraoperative decision-making.

## Abstract

Duodenal leiomyomas are rare, often asymptomatic benign tumors, typically discovered incidentally during surgery. This case highlights a unique leiomyoma found during robotic Single Anastomosis Duodeno-Ileal bypass (SADI), emphasizing the importance of intraoperative adaptability in bariatric surgery.

A 56-year-old male with a BMI of 56 kg/m2 underwent robotic SADI. Despite unremarkable preoperative endoscopy, sutures cut through a thickened duodenal wall during duodeno-ileostomy, revealing a leiomyoma on frozen section biopsy. The duodenum and distal antrum were resected, and the procedure was converted to robotic mini gastric bypass (MGB).

This rare finding underscores the challenge of detecting submucosal lesions preoperatively and the need for rapid intraoperative decision-making. Conversion to MGB achieved 90 % excess weight loss at 1-year follow-up, with no malnutrition or complications, demonstrating effective adaptation.

Surgeons performing robotic bariatric procedures must be prepared to manage unexpected pathology through flexible surgical strategies, ensuring favorable outcomes.

•Reports a rare duodenal leiomyoma found incidentally during robotic SADI, a modern bariatric procedure.•Demonstrates successful intraoperative adaptation by converting to robotic mini gastric bypass (MGB).•Achieved 90 % excess weight loss and diabetes remission at 1-year follow-up, with no complications.•Highlights the challenge of detecting submucosal lesions preoperatively, emphasizing surgical vigilance.•Validated by histopathology and frozen section biopsy, confirming benign leiomyoma.

Reports a rare duodenal leiomyoma found incidentally during robotic SADI, a modern bariatric procedure.

Demonstrates successful intraoperative adaptation by converting to robotic mini gastric bypass (MGB).

Achieved 90 % excess weight loss and diabetes remission at 1-year follow-up, with no complications.

Highlights the challenge of detecting submucosal lesions preoperatively, emphasizing surgical vigilance.

Validated by histopathology and frozen section biopsy, confirming benign leiomyoma.